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Feature Article

Medical management after control of myocardial ischaemia

Peter L Thompson, Chris Judkins, Angus G Thompson

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Abstract

After recovery from myocardial infarction, patients should receive aspirin and statin therapy and be evaluated regarding their need for coronary revascularisation, additional pharmacological treatment and possible device therapy.

Key Points

  • A large evidence base and detailed guidelines are available to help guide management after an acute coronary syndrome (ACS) but tailoring this to individual patients can be challenging.
  • Coronary revascularisation should be considered for all post-ACS patients with ongoing symptoms and critical coronary stenosis, left main disease or triple vessel coronary artery disease.
  • All post-ACS patients should be given aspirin and statins. Use of a second antiplatelet medication, a beta blocker andan ACE inhibitor is determined by symptoms and the presence of left ventricular dysfunction.
  • Prasugrel and ticagrelor are preferred over clopidogrel for use in dual antiplatelet therapy in most patients post ACS but have a higher bleeding risk.
  • Use of an implantable cardioverter defibrillator is indicated in patients who had an MI more than 40 days previously and whose ejection fraction is persistently below 35%.

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